Splenectomy in proximal gastric cancer: Frequency of lymph node metastasis to the splenic hilus

Mönig, Stefan P.; P, Collet; Baldus, Stephan; Schmackpfeffer, Katrin; Schröder, Wolfgang; Thiele, Jürgen; Dienes, Hans Peter; Hölscher, A. H.

doi:10.1002/1096-9098(200102)76:2<89::aid-jso1016>3.0.co;2-i

Cited by 109 publications

(49 citation statements)

References 16 publications

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“…In Germany, No. 10 metastasis was observed only in advanced cancer, particularly in tumors located in the greater curvature and/or type 4 tumors [26]. Our current study showed that splenectomy adversely affected survival in pSE and pN2, while there was no significant difference in survival rates in pMP, pSS, pN0, and pN1 and among Stage II, IIIA, and IIIB.…”

Section: Discussionmentioning

confidence: 50%

The Significance of Splenectomy for Advanced Proximal Gastric Cancer

Nashimoto

Yabusaki

Matsuki

2012

International Journal of Surgical Oncology

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Objectives. The significance of splenectomy in advanced proximal gastric cancer is examined retrospectively. Methods. From 1994 to 2004, 505 patients with advanced proximal gastric cancer underwent curative total gastrectomy with preserving spleen (T) for 264 patients and total gastrectomy with splenectomy (ST) for 241 patients. Results. Patients who underwent splenectomy showed more advanced lesions. The metastatic rate of lymph node (LN) in the splenic hilus (No. 10) in ST was 18.3%. As for the incidence of surgical complications, there was not statistically difference except for pancreatic fistula. The index of estimated benefit of (No. 10) LN was 4.2, which was similar to that of (No. 9), (No. 11p), (No. 11d), and (No. 16) LNs. 5-year survival rate of (No. 10) positive group was 22.2%. 5-year survival rates of pSE and pN2 in T group were better than that of pSE and pN2 in ST, respectively. The superiority of ST was not confirmed even in Stage II, IIIA, and IIIB. Conclusion. Splenectomy was not effective for patients with (No. 10) metastasis in long-term survival. Spleen-preserving total gastrectomy will be feasible and be enough to accomplish radical surgery for locally advanced proximal gastric cancer.

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Section: Discussionmentioning

confidence: 50%

The Significance of Splenectomy for Advanced Proximal Gastric Cancer

Nashimoto

Yabusaki

Matsuki

2012

International Journal of Surgical Oncology

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“…It was related to the conviction that removal of the lymph nodes located in the splenic hilum may be a prognostic marker. Several studies have concluded that the disadvantages of splenectomy outweigh the prognostic benefits for patients with gastric cancer [22, 31, 32]. The results of our analysis convinced the Gdansk surgical team to change the strategy of management and to improve the surgical quality [33].…”

Section: Discussionmentioning

confidence: 59%

Prognostic relevance of demographics and surgical practice for patients with gastric cancer in two centers: in Poland versus Germany

et al. 2011

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BackgroundAlthough studies comparing the surgical treatment of gastric carcinoma in Japan and Western industrialized countries have revealed differing survival rates, no studies to date have been performed comparing Western and Eastern Europe. This study aimed to compare demographics and surgical practice as well as the related prognostic impact on gastric cancer patients treated in Poland and Germany.MethodsThis retrospective study included gastric cancer patients treated between 1999 and 2004 by surgical departments in Gdansk (Poland) and Cologne (Germany). Univariate and multivariate analyses of demographic, histopathological, surgical, and prognostic data were performed.ResultsIncluded were 117 patients from Gdansk and 130 patients from Cologne. The Cologne patients showed higher incidence rates of serious comorbidity, pT1 cancer, and distant metastasis than those from Gdansk. Indications for and frequency of selected surgical procedures differed significantly. D2-lymphadenectomy was performed in 89% of the Cologne patients, while D1-lymphadenectomy was done for 85% of the Gdansk patients. Univariate analysis yielded a 5-year survival rate of 28.3% for the Gdansk patients, and 40.3% for the Cologne patients (p = 0.056). Independent prognostic factors were pT category (p = 0.002), pN category (p < 0.001), pM category (p = 0.027), residual tumor (R) category (p = 0.004), age (p = 0.012), and number of resected lymph nodes (p = 0.005).ConclusionsSignificant differences of clinical and surgical parameters exist between gastric cancer patients treated in Poland and Germany. In addition to established independent prognostic factors, we found that survival improved with each additionally resected lymph node.

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“…Splenectomy was performed (n = 35) in cases of proximal gastric carcinoma (types II and III) and in cases of metastatic infiltration of the splenic hilar nodes (No. 10), but not as a general rule [16]. …”

Section: Methodsmentioning

confidence: 99%

Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy

et al. 2005

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BackgroundRisk adjustment and stratification play an important role in quality assurance and in clinical research. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is a patient risk prediction model based on 12 patient characteristics and 6 characteristics of the surgery performed. However, because the POSSUM was developed for quality assessment in general surgical units, its performance within specific subgroups still requires evaluation.The aim of the present study was to assess the accuracy of POSSUM in predicting mortality and morbidity in patients with gastric cancer undergoing D2-gastrectomy.Methods137 patients with gastric cancer undergoing gastrectomy were included in this study. Detailed, standardized risk assessments and thorough documentation of the post-operative courses were performed prospectively, and the POSSUM scores were then calculated.ResultsThe 30- and 90- day mortality rates were 3.6% (n = 5) and 5.8% (n = 8), respectively. 65.7% (n = 90) of patients had normal postoperative courses without major complications, 14.6% (n = 20) had moderate and 13.9% (n = 19) had severe complications. The number of mortalities predicted by the POSSUM-Mortality Risk Score (R1) was double the actual number of mortalities occurring in the median and high-risk groups, and was more than eight times the actual number of mortalities occurring in the low-risk group (R1 < 20%). However, the calculated R1 predicted rather well in terms of severe morbidity or post-operative death in each risk group: in predicted low risk patients the actual occurrence rate (AR) of severe morbidity or post-operative death was 14%, for predicted medium risk patients the AR was 23%, and for predicted high risk patients the AR was 50% (p < 0.05). The POSSUM-Morbidity Risk Score (R2) overestimated the risk of morbidity.ConclusionThe POSSUM Score may be beneficial and can be used for assessment of the peri- and post-operative courses of patients with gastric carcinoma undergoing D2-gastrectomy. However, none of the scores examined here are useful for preoperative prediction of postoperative course.

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Splenectomy in proximal gastric cancer: Frequency of lymph node metastasis to the splenic hilus

Abstract: Based on our data lymph node metastasis to the splenic hilus is rarely observed in proximal gastric cancer and only found in advanced cancer (UICC IIIb/IV) especially in tumors of the greater curvature and of Borrmann type IV cancer.

Cited by 109 publications

References 16 publications

The Significance of Splenectomy for Advanced Proximal Gastric Cancer

The Significance of Splenectomy for Advanced Proximal Gastric Cancer

Prognostic relevance of demographics and surgical practice for patients with gastric cancer in two centers: in Poland versus Germany

Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy

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